Headache

Question 1

What is the difference between primary and secondary headache?

Answer 1

Primary headache has no underlying causes, while secondary headache has an identifiable structural or biochemical cause.

Question 2

What are the types of primary headache?

Answer 2

Migraine, tension type headache, cluster headache.

Question 3

What is thought to be the cause of primary headache?

Answer 3

Problems in the brainstem, corticospinal cord, and trigeminal vascular system, as well as calcitonin gene peptide problems.

Question 4

How to deal with primary headaches?

Answer 4

Modify lifestyle triggers, abortive treatments (i.e., stop unnecessary medications), and preventive treatments (take medication when it first starts).

Question 5

Is investigation required for primary headache?

Answer 5

None in most cases unless a secondary cause is suspected.

Question 6

What type of imaging can be used for headaches?

Answer 6

MRI, CT, and CT angiogram.

Question 7

What is a tension type headache?

Answer 7

A headache that is not disabling, characterized by light pain in the head and some tightening.

Question 8

What percent of people have a tension type headache?

Answer 8

40-50%.

Question 9

Does anything make tension type headache worse?

Answer 9

No, it is not affected by physical activity.

Question 10

What is the treatment for tension type headache?

Answer 10

Paracetamol and NSAIDs, tricyclic antidepressants.

Question 11

How common is migraine?

Answer 11

About 10-20% of people suffer from them.

Question 12

What are the premonitory changes in a migraine?

Answer 12

Mood change, fatigue, cognitive changes, muscle pain, food cravings.

Question 13

What is the early headache stage in migraine?

Answer 13

Dull headache, nasal congestion, muscle pain.

Question 14

What is the advanced headache phase in a migraine?

Answer 14

Unilateral headache, throbbing, nausea, photophobia, phonophobia, osmophobia (fear of odors).

Question 15

What is the postdrome of migraine?

Answer 15

Fatigue, cognitive changes, muscle pain.

Question 16

What are the stages of migraine in order?

Answer 16

Premonitory, aura, early headache, advanced headache, postdrome.

Question 17

What percent of people with migraines are affected by the aura?

Answer 17

33%.

Question 18

What is the cause of aura in migraine?

Answer 18

Transient neurological symptoms from cortical or brainstem dysfunction.

Question 19

What are the signs of aura in migraine?

Answer 19

Speech changes, motor or visual symptoms lasting 15-60 minutes.

Question 20

What is the aura associated with in migraine?

Answer 20

TIA.

Question 21

What is the criteria for episodic migraine?

Answer 21

Less than 15 days per month.

Question 22

What are low and high frequency episodic migraines?

Answer 22

Low frequency: 1-9 per month, high frequency: 10-14 per month.

Question 23

What is chronic migraine classification?

Answer 23

Headache that occurs 15 or more days per month for 3 months or more, with at least 8 days per month being a headache.

Question 24

What are the signs of chronic migraines?

Answer 24

Previous episodic migraines, increased frequency of migraine symptoms, less frequent migraine symptoms, episodes of severe migraine on a background of less severe headaches.

Question 25

How frequent is a medication overuse headache?

Answer 25

More than 15 days a month.

Question 26

How much local pain relief should someone with migraine take?

Answer 26

No more than 15 days per month for migraine or 10 per day for opioids or ergots.

Question 27

What are the prophylactic treatment examples for migraines?

Answer 27

Propranolol, tricyclic antidepressants, candesartan.

Question 28

What are second line migraine treatments?

Answer 28

Topiramate, flunarizine, Botox, CGRP monoclonal antibodies.

Question 29

How is migraine affected in pregnancy?

Answer 29

It gets better in pregnancy if there is no aura; if there is an aura, it is not affected in pregnancy.

Question 30

Should OCP be stopped if a migraine with aura occurs?

Answer 30

Yes.

Question 31

How long does it take for overuse migraine to get better?

Answer 31

2-4 weeks.

Question 32

What are cranial neuralgias symptoms?

Answer 32

Intense burning or stabbing pain, normally brief but severe, travels the course of the affected nerve due to irritation of the nerve.

Question 33

What is the cause of cranial neuralgias?

Answer 33

Irritation of nerves that have sensation in the head, including trigeminal, glossopharyngeal, vagus, nervus intermedius, and occipital.

Question 34

What is trigeminal neuralgia?

Answer 34

Spontaneous stabbing pain in the trigeminal area lasting about 5-10 seconds.

Question 35

What are triggers of trigeminal neuralgia?

Answer 35

Wind, touch, chewing.

Question 36

What is the cause of trigeminal neuralgia?

Answer 36

Vascular compression of the nerve, multiple sclerosis, intracranial arteriovenous malformation, intracranial tumor, brainstem lesion.

Question 37

What is the medical treatment for trigeminal neuralgia?

Answer 37

Carbamazepine, oxcarbazepine, lamotrigine (less effective as it takes a long time to build up effectiveness).

Question 38

What are the surgical treatments for trigeminal neuralgia?

Answer 38

Glycerol ganglion injection/balloon compression, stereotactic radiosurgery, microvascular decompression.

Question 39

What are trigeminal autonomic cephalalgias?

Answer 39

Headaches associated with trigeminal nerve issues and sympathetic problems.

Question 40

Where is the pain in cluster headaches?

Answer 40

Orbital and temporal.

Question 41

Are the attacks in cluster headaches bilateral or unilateral?

Answer 41

Unilateral.

Question 42

How long do cluster headaches last?

Answer 42

15 minutes to 3 hours.

Question 43

How quick is the onset of cluster headaches?

Answer 43

Within 9 minutes.

Question 44

What are the migraine symptoms in cluster headaches?

Answer 44

Tiredness and yawning, nausea, vomiting, photophobia, phonophobia, aura.

Question 45

How long do bouts of cluster headaches last?

Answer 45

1-3 months, normally at the same time of the day.

Question 46

How frequent are cluster headaches during bouts?

Answer 46

1 every other day to 8 per day.

Question 47

What is the abortive treatment for cluster headaches?

Answer 47

Triptans (up to 2 times per day), oxygen therapy (need 2 tanks per day).

Question 48

Can you get medication overuse headache in cluster headaches?

Answer 48

No.

Question 49

What is the transitional treatment for cluster headaches?

Answer 49

Oral prednisone for 1 week, greater occipital nerve block with lidocaine and depomedrone.

Question 50

What is the preventative treatment for cluster headaches medically?

Answer 50

Verapamil (this requires ECG monitoring), lithium, topiramate, melatonin.

Question 51

What are the surgical treatments for cluster headaches?

Answer 51

Occipital nerve stimulation, deep brain stimulation.

Question 52

What are the symptoms of paroxysmal hemicrania?

Answer 52

Pain in orbital and temporal lobes, sudden and severe, always unilateral.

Question 53

How long does paroxysmal hemicrania last?

Answer 53

2-30 minutes.

Question 54

What are the triggers for paroxysmal hemicrania?

Answer 54

Rotating head.

Question 55

What can help hemicrania?

Answer 55

Indometacin.

Question 56

What is hemicrania continua?

Answer 56

A unilateral headache that can last months without getting better.

Question 57

Does hemicrania have worsening points?

Answer 57

Yes, it can get worse for 20 minutes to days.

Question 58

What is SUNCT?

Answer 58

A headache that is frequent and causes pain in a specific area.

Question 59

What are the triggers for SUNCT?

Answer 59

Wind, cold, touch, chewing.

Question 60

What is the pain associated with in SUNCT?

Answer 60

Conjunctival injection and lacrimation.

Question 61

What is the medical treatment for SUNCT?

Answer 61

Lamotrigine (first line), topiramate, oxcarbazepine.

Question 62

What is the transitional treatment for SUNCT?

Answer 62

Gon block.

Question 63

What are the surgical treatments for SUNCT?

Answer 63

Occipital nerve stimulation, deep brain stimulation.

Question 64

What are some signs of a secondary headache?

Answer 64

A headache that occurs for the first time in a temporal relation to another disorder, or a preexisting primary headache that becomes significantly worse in the temporal area. Sudden onset (thunderclap), new patient, change in pattern, new onset and older than 50, immunosuppression, focal symptoms, non-focal symptoms, neck stiffness, high pressure, low pressure.

Question 65

What are the signs of high pressure headache?

Answer 65

Made worse by lying down, wakes the patient up, made worse due to physical exertion, happens due to Valsalva maneuver, seizures, progressive focal symptoms, headache.

Question 66

What are the signs of a low pressure headache?

Answer 66

It is caused by sitting up.

Question 67

How long until a thunderclap headache reaches peak?

Answer 67

Less than 1 minute.

Question 68

Is a thunderclap headache part of a whole head or howel head?

Answer 68

Whole head.

Question 69

What is the differential diagnosis for thunderclap headache?

Answer 69

Migraine, primary exertional headache, subarachnoid hemorrhage, TIA, stroke, carotid/vertebral artery dissection, cerebral venous thrombosis, meningitis, pituitary apoplexy.

Question 70

Where does a subarachnoid hemorrhage occur?

Answer 70

Bleeding into the subarachnoid space.

Question 71

What are the complications of subarachnoid hemorrhage?

Answer 71

Vasospasm, hydrocephalus, seizure, infection, rebleeding.

Question 72

What investigations are done for SAH?

Answer 72

CT head, CT angiogram, LP (if CT head negative - need to wait 12 hours).

Question 73

What is the treatment for subarachnoid hemorrhage?

Answer 73

Coiling of aneurysms, nimodipine (Ca2+ blocker for vasodilation), triple H therapy.

Question 74

What are the causes of high brain pressure?

Answer 74

Tumor, infection, hydrocephalus, intracranial hypertension.

Question 75

What are the signs of high pressure headache?

Answer 75

Papilledema, new abnormal neurologic exam.

Question 76

What are the symptoms of intracranial hypertension?

Answer 76

Progressive episodic headaches, visual obscuration or pulsatile tinnitus, papilledema with large blind spot.

Question 77

What are the symptoms of intracranial hypotension?

Answer 77

Postural headache, gets worse when sitting up.

Question 78

What is the sign on MRI of intracranial hypotension?

Answer 78

Venous engorgement, subdural hygromas.

Question 79

What is the treatment for intracranial hypotension?

Answer 79

Bed rest, IV caffeine, epidural blood patch.

Question 80

What is an epidural blood patch?

Answer 80

Epidural space is opened and patient's own blood is injected into it.

Question 81

What is giant cell arteritis?

Answer 81

Inflammation of the giant cells.

Question 82

What are the signs of giant cell arteritis?

Answer 82

Headache, scalp tenderness, jaw claudication, visual disturbances, systematically unwell, enlarged temporal arteries.

Question 83

What tests should be done for giant cell arteritis?

Answer 83

ESR blood test, CRP blood test.

Question 84

What is the treatment for giant cell arteritis?

Answer 84

High dose prednisolone.